N.J. Admin. Code § 11:20-24.2

Current through Register Vol. 57, No. 1, January 6, 2025

Section 11:20-24.2 - Eligibility, issuance, and continued coverage

(a) The policyholder of a standard health benefits plan or a standard health benefits plans with rider shall be a resident, as defined at N.J.A.C. 11:20-1.2. A carrier may require reasonable proof of residency. A dependent of the policyholder may be a nonresident of New Jersey, but is not eligible to be covered under the policy if he or she resides outside of the United States.

(b) An eligible person may apply for coverage under a standard health benefits plan or standard health benefits plan with rider during:

1. An annual open enrollment period; or

2. A special enrollment period.

(c) An eligible person may apply for coverage under a catastrophic plan only if:

1. The person is either under 30 years old as of the date the coverage would take effect; or

2. The person has received a notice with an exemption certificate number (ECN) from the Marketplace that indicates that he or she qualifies for an exemption.

(d) After obtaining coverage under a standard health benefits plan or standard health benefits plan with rider, a covered person may elect to retain his or her coverage if he or she later becomes eligible for or covered under Medicare.

(e) After obtaining coverage under a catastrophic plan, a covered person may elect to retain his or her coverage until the effective date of a Marketplace redetermination of exemption eligibility that finds the person is no longer eligible for an exemption or until the end of the plan year in which any person covered under the contract attains age 30, whichever occurs first.

(f) A carrier shall issue a standard health benefits plan or standard health benefits plan with rider to any eligible person who requests it and pays the premiums therefor, except that a carrier offering network-based plans may refuse to issue coverage to an eligible person that does not live in the carrier's approved service area for the network associated with the plan for which application is made, and except as provided in N. J.AC. 11:20-11.

N.J. Admin. Code § 11:20-24.2

Amended by 48 N.J.R. 2153(a), effective 10/17/2016

Amended by 50 N.J.R. 2329(a), effective 11/19/2018